Neurosurgery
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Review Case Reports
Spinal arachnoid cyst related to a nonaneurysmal perimesencephalic subarachnoid hemorrhage: case report.
We report the first case of a delayed symptomatic spinal arachnoid cyst related to a nonaneurysmal perimesencephalic hemorrhage. We review the literature concerning posthemorrhagic spinal arachnoid cysts. ⋯ This extremely rare complication should be kept in mind when delayed lower-limb neurological deficits appear after subarachnoid hemorrhage, even in a perimesencephalic form.
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Comparative Study
Effects of 23.4% sodium chloride solution in reducing intracranial pressure in patients with traumatic brain injury: a preliminary study.
Mannitol is the standard of care for patients with increased intracranial pressure (ICP), but multiple administrations of mannitol risk renal toxicity and fluid accumulation in the brain parenchyma with consequent worsening of cerebral edema. This preliminary study assessed the safety and efficacy of small-volume injections of 23.4% sodium chloride solution for the treatment of intracranial hypertension in patients with traumatic brain injury who became tolerant to mannitol. ⋯ This study suggests that 23.4% hypertonic saline is a safe and effective treatment for elevated ICP in patients after traumatic brain injury. These results warrant a rigorous evaluation of its efficacy as compared to mannitol in a prospective randomized controlled trial.
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Comparative Study
Visual field preservation after curative multi-modality treatment of occipital lobe arteriovenous malformations.
Occipital lobe arteriovenous malformations (AVMs) provide challenging management decisions because of their proximity to the visual cortex and optic radiations. Preservation of visual function throughout treatment is the mainstay of therapeutic planning. We reviewed visual field (VF) outcomes of all patients who received curative treatment for occipital AVMs at Stanford University to evaluate the efficacy of different treatment strategies. ⋯ Occipital AVMs can be safely cured using multimodality strategies with minimal risk to visual function despite the proximity of these lesions to the visual cortex and associated pathways.
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Medical treatment of Tourette syndrome is often ineffective or is accompanied by debilitating side effects, therefore prompting the need to evaluate surgical therapies. ⋯ Our findings suggest that stimulation of the anterior internal capsule may be a safe and effective procedure for the treatment of Tourette syndrome.
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Comparative Study
Techniques for aspirating bone marrow for use in spinal surgery.
The osteogenicity of bone marrow has been well documented in the literature. The use of bone marrow as a source of osteoprogenitor cells for spinal fusion surgery is increasing. Improper aspiration technique can lead to dilution of bone marrow and a subsequent reduction in osteoprogenitor cells. Therefore, correct aspiration technique is imperative to the successful use of bone marrow with various grafting combinations. ⋯ Clinical studies currently under way will answer the question of bone marrow efficacy in spinal fusion surgery.